Acute Renal Failure and Renal Replacement Therapy in the Postoperative Period of Orthotopic Liver Transplant Patients Versus Nonelective Abdominal Surgery Patients

Abstract

Acute renal failure (ARF) often complicates the postoperative period of patients undergoing orthotopic liver transplantation (OLT); it is habitually associated with high mortality rates. Similarly, patients undergoing major nonelective abdominal surgery are prone to ARF because of their frequent preexistent morbidities, abdominal sepsis, and needed for extended surgical procedures. The aim of this study was to evaluate the incidence of ARF and use of renal replacement therapy (RRT) among OLT versus nonelective abdominal surgery patients and associations with clinical outcomes. We studied all the patients admitted to a surgical intensive care unit (ICU) from January 2008 to December 2009 after OLT or nonelective abdominal surgery. The inclusion criteria were an ICU stay of at least 48 hours and without prior end-stage renal failure. OLT patients (n=84) were younger and less severly ill than surgery patients (n=60). ARF occurrence was lower among the OLT (29%) than the surgery group (47%) requiring RRT in 71% and 53% of patients due to ARF, respectively. The ICU mortality of ARF patients in both groups (29% OLT and 51% surgery) were greater than among subjects without ARF (2% and 6%). The occurrence of ARF is common among these two patient groups, and associated with increased risk of death among in surgery (+45%) versus in OLT (+27%) patients.

Risk factors of acute kidney injury after orthotopic liver transplantation in China

“…In the study, we discovered that the incidence rate of post-OLT AKI was 3.97%, which was less than the 11.1–90% reported in previous studies 1 3 6 35 36 37 , and similar to the finding of Kirnap et al .’s study (5%) 20 . This relatively low occurrence rate benefited from the development of transplantation surgery and application of precautionary measures to prevent complications after OLT 17 18 22 38 .…”

A meta-analysis of complications following deceased donor liver transplant

“…(39-53) Thirteen studies reported rates of acute renal failure, with a pooled proportion = 0.299 (95% CI = 0.220 to 0.385). 3 studies reported rates of acute renal failure with a temporary need for dialysis (pooled proportion = 0.195 (95% CI = 0.063, 0.377)).…”

Contrast‐enhanced ultrasound assessed renal microvascular perfusion may predict postoperative renal complications following colorectal surgery

“…4,26 This had led to calls to ensure adequate fluid status and inotropic support to maintain renal microperfusion, although it has been acknowledged that to date there is no reliable test to monitor renal blood flow when fluid challenges and inotropes are given. 5,27,28 CEUS may offer this monitoring to ensure optimum real-time renal perfusion and potentially reduce renal complications secondary to poor blood flow and renal hypoxia. correlation between CEUS assessed renal blood flow and serum creatinine.…”